Ali N Kaddoura, M.D.

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

AK060472 Issued in MI

Practice address

24825 Michigan Ave
Suite B
Dearborn, MI 48124-1757

Phone

(313) 565-3365

Fax

(313) 565-3440

NPI assigned

Jun 17, 2006

Last updated

Dec 18, 2009By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Independent Medical Associates PC

  • Specialist
  • Dearborn, MI
  • NPI 1568889251
  Authorized official Same address or phone
• Affiliated Medical of Dearborn P.L.L.C.

  • Diagnostic Radiology Physician
  • Dearborn, MI
  • NPI 1235109786
  NPD (past)
• Truesthetix PLLC

  • Internal Medicine Physician
  • Dearborn, MI
  • NPI 1740166545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1150502400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1261094400000",
    "number": "1649215377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24825 MICHIGAN AVE",
            "address_2": "SUITE B",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241757",
            "telephone_number": "313-565-3365",
            "fax_number": "313-565-3440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24825 MICHIGAN AVE",
            "address_2": "SUITE B",
            "city": "DEARBORN",
            "state": "MI",
            "postal_code": "481241757",
            "telephone_number": "313-565-3365",
            "fax_number": "313-565-3440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KADDOURA",
        "first_name": "ALI",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-17",
        "last_updated": "2009-12-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MI",
            "license": "AK060472",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3241017",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Haley Marie Jurczyszyn, DPT
• Jure Grahovac, M.D., P.C.
• Fatima Kaafarani, NP
• Safa Kabbani
• Debora Ann Kaczynski, M.D.
• Wafah Jawad Kadhim, MD
• Zahraa Ali Kadhim
• Mohamed Rami Kadi, DO
• Essa Kadiri, MD
• Halla Kadouh, FNP-BC

• Internal Medicine Physician in Dearborn, MI
• Providers in Dearborn, MI by specialty
• Internal Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.